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Doctors Lounge - Oncology Answers
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| Anonymous
- Sat Jan 11, 2003 5:08 pm |
|
My wife has undergone (6) blood transfusions within the past 5 months, and has recently been diagnosed with this disease. She has chosen not to undergo marrow/chemo therapy. Can anyone tell me what forms of, if any, alternative treatments are available?
Thank you.
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| Dr. Safaa Mahmoud
- Tue Jan 14, 2003 6:05 am |
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 Dear chief, sorry for your wife.
From your email I understood that she has refractory anaemia and I wonder why chemotherapy was recommended. Are there blast cells in her bone marrow or in the peripheral blood?
First of all you have to know that the standard of care in myelodysplastic syndrome (MDS) is generally accepted to be supportive care.
Although, there is marked heterogeneity in MDS, an indolent course is generally seen in patients with RA (refractory anaemia) or RARS (refractory anaemia with ringed sideroblast). Basically they should be carefully observed if they develop significant cytopenias (including anemia, neutopenia, and thrombocytopenia)and complications (repeated infections, bleeding etc).
Patients with anemia may be transfused with packed red cells when symptoms (easy fatigability, dizziness, headache, blurring of vision etc) develop like I think the case with your wife. For those who started transfusion at young age iron chelating agents should be considered which is found also to decrease the transfusion frequency. If the frequency of transfusions increases (e.g., more than 1 to 2 per month), trials of high doses of vitamins e.g., B(6)) or androgens could benefit. Erythropoietin has improved anemia and reduced transfusion requirements in up to 25% of patients.
Immunomodulatory therapy with corticosteroids, cyclosporin A, and ATG may benefit 30% to 50% of selected patients who has hypoplastic marrow ( immunosuppression is thought to be pathophysiology). Differentiating agents including vitamin D, vitamin A, retinoids were associated with low response rate.
Cytarabine (chemotheraputic agent) in MDS showed response rates of 10% to 15% with no survival benefit. For stem cell transplantation (STC) most of the studies have shown that SCT may benefit high-risk MDS patients refractory anemia with eccess blasts and refracory anemia with eccess blasts in transformation) ( RAEB and RAEBT) which is not in our case as far as Iunderstood from your email.
Novel agents and strategies like monoclonal antibodies modulators for apoptosis etc are under investaigations and almost all are applied to high risk ppatients.
Best of luck.
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